When prepping for the NCLEX exam, it is important to have a strategic study plan in place. One part of the plan should include practicing NCLEX-style questions, especially in specific nursing areas such as pediatrics.
Pediatric nursing is a specialty that provides care to children from birth to adulthood. One vital role pediatric nurses play is administering vaccines. The nurse should know the childhood vaccination schedule, how to properly administer vaccines, and how to educate patients and parents about vaccinations. The NCLEX exam tests applicants on this type of material.
In this article, you will learn some tips on how to answer a “select all that apply” NCLEX-style question that focuses on a pediatric patient. “Select all that apply” questions are set up in way that allows for more than one correct answer. Therefore, the student should choose wisely because there is no partial credit given on the NCLEX exam.
NCLEX Practice Question: Childhood Vaccines
A 2-month-old arrives to the clinic for a well-child visit. While collecting a health history, the mother reports that the child received the Hepatitis B vaccine at birth, has no pertinent medical/surgical history, takes no medications, and has no allergies. The child’s vital signs are the following: heart rate 123, respirations 34, and temperature 98.7 ‘F. Which of the following options are incorrect statements regarding the care you will provide to this child? (Select all that apply)
- Prepare the child for DTaP, Hib, IPV, PCV, HepB, and RV vaccines.
- It is best to administer the intramuscular vaccines in the dorsogluteal muscle.
- Educate the mother about soreness, swelling, and redness that may occur at the injection site, and inform her that a cold compress can be used to relieve pain at the site.
- Prepare the child for DTaP, Hib, IPV, MMR, and RV vaccines.
- Provide education to the mother about how to administer Aspirin (if needed) for fever or pain at the injection site.
- The rotavirus vaccine is the only vaccine the patient will be receiving orally during this visit.
Tip 1: Critically analyze the information that is provided in the question BEFORE looking at the options!
When a question provides information that includes a patient’s age, reason for visit, health history information, or vital sign readings, it is important to ask yourself the following questions BEFORE looking at the options in this particular question:
- “What happens at a typical well-child visit for a 2-month-old?”
Answer: vaccinations (this should lead you to think about the next question).
- “What vaccinations are given to a 2-month-old child?”
Answer: The first doses of diphtheria, tetanus, acellular pertussis (DTaP), Haemophilus influenzae type b (Hib), inactivated poliovirus vaccine (IPV), pneumococcal conjugate vaccine (PCV), rotavirus vaccine (RV), and a second dose of hepatitis B, also called HepB, if the child has already received the first dose at birth.
- “Is there anything important in the child’s health history since the child will be receiving the vaccinations listed above?”
Answer: YES! It is important to know that the child has received the first dose of the hepatitis B vaccine, because today the patient will receive a second dose. If the child did not receive the first dose of hepatitis B at birth, then you would administer the first dose instead of the second during this visit. The patient’s allergies and medical/surgical history is another important piece of information. For example, children who have a severe allergy to neomycin, streptomycin, or polymyxin B should not receive the IPV (inactivated poliovirus vaccine), and children who’ve had a history of intussusception should not receive the rotavirus vaccine. This patient has experienced neither.
- “Are the child’s vital signs within normal range?”
Answer: Based on the child’s age, these vital sign readings are normal for a 2-month-old. It is important to take note of a child’s vital signs prior to administering vaccines to ensure the patient is not too sick to receive them. If this was the case, the vaccinations would be rescheduled. However, minor illnesses or colds should not prevent the administration of vaccines to a child.
- Lastly, ask yourself, “What is this question asking?”
This question wants to know which options are NOT something a nurse would perform for a 2-month-old during this particular visit. In other words, which statements are false? However, keep in mind that there might more than one false statement, as the words “select all that apply” indicate.
Tip 2: Start eliminating false options by asking yourself, “Is this a true or false statement?”
- Prepare the child for DTaP, Hib, IPV, PCV, HepB, and RV vaccines. True!
A 2-month-old child should receive these vaccines, which is what we already realized when analyzing the question at the beginning.
- It is best to administer the intramuscular vaccines in the dorsogluteal muscle. False!
The dorsogluteal muscle is not used in children less than the age of three for vaccinations, because the muscle is not fully developed. It is best to use the vastus lateralis muscle in an infant.
- Educate the mother about soreness, swelling, and redness that may occur at the injection site, and inform her that a cold compress can be used to relieve pain at the site. True!
This is a common reaction after administering vaccines. The mother should be informed that it is normal and that cold compresses help with pain.
- Prepare the child for DTaP, Hib, IPV, MMR, and RV vaccines. False!
This is quickly eliminated because option A is correct. The first dose of the MMR (measles, mumps, and rubella) vaccine is not administered until the child is between 12 and 15 months of age. Also, the option is missing the first dose of PCV and the second dose of HepB, which the patient will receive during this visit.
- Provide education to the mother about how to administer Aspirin (if needed) for fever or pain at the injection site. False!
Aspirin should never be given to an infant because of the increased risk of developing Reye’s syndrome. Age-appropriate and weight-based doses of Tylenol may be ordered by the physician if the child has discomfort, but not Aspirin. Therefore, this option is false!
- The rotavirus vaccine is the only vaccine the patient will be receiving orally during this visit. True!
The rotavirus vaccine is an oral suspension the child swallows. All the other vaccines are given intramuscularly, except IPV which may be administered subcutaneously or intramuscularly.
Answer to this question: B, D, E
The NCLEX examination can be tricky, so it’s important to apply critical thinking techniques to each question. Once you pass the NCLEX exam, you’ll finally become a licensed nurse. However, why stop there? You can further your education with online learning opportunities by earning a master’s or doctorate degree in nursing.
By advancing your education, you can pursue new career opportunities and grow professionally as a nurse.
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